Provider Demographics
NPI:1487889341
Name:LO, CHIN-YU JEAN (MD)
Entity type:Individual
Prefix:
First Name:CHIN-YU
Middle Name:JEAN
Last Name:LO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:CHIN-YU
Other - Middle Name:JEAN
Other - Last Name:LUO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:3916 STATE ST
Mailing Address - Street 2:#300
Mailing Address - City:SANTA BARBARA
Mailing Address - State:CA
Mailing Address - Zip Code:93105-5602
Mailing Address - Country:US
Mailing Address - Phone:805-563-3011
Mailing Address - Fax:805-564-5087
Practice Address - Street 1:43830 10TH ST W
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:CA
Practice Address - Zip Code:93534-4826
Practice Address - Country:US
Practice Address - Phone:661-940-1421
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-05-21
Last Update Date:2010-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA106147207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CACJ866ZMedicare PIN
CACJ866XMedicare PIN
CACJ866WMedicare PIN